HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vitale, G. D. Articles by Beanlands, R. S.B. Search for Related Content PubMed PubMed Citation Articles by Vitale, G. D. Articles by Beanlands, R. S.B.

Myocardial Glucose Utilization and Optimization of ¹⁸F-FDG PET Imaging in Patients with Non–Insulin-Dependent Diabetes Mellitus, Coronary Artery Disease, and Left Ventricular Dysfunction

Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

In patients with non–insulin-dependent diabetes mellitus (NIDDM), FDG PET imaging is often problematic because of poor uptake of FDG. Different protocols have been used; however, these have not been directly compared in patients with NIDDM who have both coronary artery disease (CAD) and severe left ventricular (LV) dysfunction, for which defining viability is most relevant. The aim of this study was to better define the optimal means of FDG PET imaging, assessed by image quality and myocardial glucose utilization rate (rMGU), among 3 imaging protocols in patients with NIDDM, CAD, and severe LV dysfunction. Methods: Ten patients with NIDDM, CAD, and severe LV dysfunction (mean ejection fraction, 29.8% ± 7.1%) underwent dynamic FDG PET scanning using 3 different protocols: the standard protocol, consisting of oral glucose loading or a supplemental insulin bolus based on fasting glucose; the niacin protocol, consisting of pretreatment with niacin to lower free fatty acids; and the insulin clamp protocol, consisting of hyperinsulinemic euglycemic clamp. Image quality was satisfactory with at least 1 approach in 8 patients, who formed the primary analysis group. Results: Myocardium–to–blood-pool ratios were significantly higher with the insulin clamp (standard, 1.7 ± 1.2; niacin, 1.6 ± 1.0; insulin clamp, 3.4 ± 2.5 [P < 0.05 vs. standard and niacin]). Values for rMGU were higher with the insulin clamp (standard, 0.11 ± 0.07 µmol/g/min; niacin, 0.12 ± 0.11 µmol/g/min; insulin clamping, 0.22 ± 0.12 µmol/g/min [P = 0.004 vs. standard and 0.07 vs. niacin]). Conclusion: The hyperinsulinemic euglycemic clamp yielded the highest FDG PET image quality and the highest rMGU in a comparison with the standard and niacin protocols in this difficult group of patients with NIDDM, CAD, and severe LV dysfunction. The hyperinsulinemic euglycemic clamp may be the preferred method for FDG PET viability imaging in this population. Larger clinical trials are needed to assess whether accuracy is greater with this approach.

Key Words: FDG • PET • diabetes mellitus • coronary disease • myocardial dysfunction

This article has been cited by other articles:

				R. S.B. Beanlands, G. Nichol, E. Huszti, D. Humen, N. Racine, M. Freeman, K. Y. Gulenchyn, L. Garrard, R. deKemp, A. Guo, et al. F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction and Suspected Coronary Disease: A Randomized, Controlled Trial (PARR-2) J. Am. Coll. Cardiol., November 13, 2007; 50(20): 2002 - 2012. [Abstract] [Full Text] [PDF]

				S. Neubauer The Failing Heart -- An Engine Out of Fuel N. Engl. J. Med., March 15, 2007; 356(11): 1140 - 1151. [Full Text] [PDF]

				K. Thompson, G. Saab, D. Birnie, B. J.W. Chow, H. Ukkonen, K. Ananthasubramaniam, R. A. deKemp, L. Garrard, T. D. Ruddy, J. N. DaSilva, et al. Is Septal Glucose Metabolism Altered in Patients with Left Bundle Branch Block and Ischemic Cardiomyopathy? J. Nucl. Med., November 1, 2006; 47(11): 1763 - 1768. [Abstract] [Full Text] [PDF]

				A. F.L. Schinkel, J. J. Bax, R. Valkema, A. Elhendy, R. T. van Domburg, E. C. Vourvouri, M. A. Bountioukos, E. P. Krenning, J. R.T.C. Roelandt, and D. Poldermans Effect of Diabetes Mellitus on Myocardial 18F-FDG SPECT Using Acipimox for the Assessment of Myocardial Viability J. Nucl. Med., June 1, 2003; 44(6): 877 - 883. [Abstract] [Full Text] [PDF]

				R. S. B. Beanlands, T. D. Ruddy, R. A. deKemp, R. M. Iwanochko, G. Coates, M. Freeman, C. Nahmias, P. Hendry, R. J. Burns, A. Lamy, et al. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1735 - 1743. [Abstract] [Full Text] [PDF]